Aspergillus species endocarditis. The new face of a not so rare disease

Aspergillus flavus endocarditis developed in a 13 year old girl after mitral valve replacement. Thirty-nine other cases of Aspergillus species endocarditis were found in the medical literature. Twenty-nine of these infections occurred in postcardiac surgery patients. Fever was the most common presenting manifestation (35 patients). Cardiac murmurs were present in 25. Lesions were in the left side of the heart in 38 (95 per cent), and there were major arterial emboli in 33 (83 per cent).The diagnosis was made antemortem in only nine patients. The diagnostic specimen in eight of these was an embolus. Aspergillus sp. were cultured from the blood of only three (8 per cent). Two (5 per cent) patients survived; in both infected prostheses were replaced, and one received antifungal chemotherapy. Aspergillus sp. endocarditis should be suspected in any postcardiac surgery patient presenting with endocarditis and emboli whose blood yields no organisms in culture.Careful surveillance and control of fungal contamination of the surgical environment is urged. Cultures of arterial blood should be obtained, and both solid and liquid microbiological media utilized. Early valve replacement and chemotherapy with both amphotericin B and flucytosine are recommended.